| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,010 |
1,007 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
274 |
272 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
885 |
878 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
265 |
264 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
520 |
453 |
$6K |
| 92341 |
|
159 |
159 |
$4K |
| 92015 |
Determination of refractive state |
311 |
308 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$764.82 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$620.03 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
12 |
$600.12 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$515.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$192.23 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$77.10 |